腹横筋膜阻滞在老年患者全麻腹腔镜结肠癌根治手术中的应用

Application of transverse abdominal fascia block in laparoscopic radical operation of colon cancer under general anesthesia in elderly patients

目的探究腹横筋膜阻滞在老年患者全麻腹腔镜结肠癌根治手术中的应用及术后镇痛效果。方法回顾性研究首都医科大学附属北京世纪坛医院2017年1月到2019年1月间的老年(≥60岁)全麻腹腔镜下结肠癌根治手术共68例,分为两组其中行腹横筋膜阻滞为TAP组(31例),未行腹横筋膜阻滞为NTAP组(37例),比较术中两组患者入室后(T0)、手术开始前5min(T1)、手术开始后5min(T2)、出室前5min(T3)的平均动脉压,术中瑞芬太尼用量,术后1h、12h、24hVAS疼痛视觉模拟评分,患者术后PCA次数及患者术后恶心呕吐情况。结果两组患者在T0、T1平均动脉压无统计学差异(P>0.05),但T2、T3两组患者的平均动脉压存在统计学意义(P<0.05),且NTAP组在T1、T2平均动脉压存在统计学差异(P<0.05),而TAP组则无统计学差异(P>0.05);TAP组术中瑞芬太尼总用量明显低于NTAP组,具有统计学差异(P<0.05);术后镇痛方面,术后1h及12h患者VAS评分TAP组明显低于NTAP组(P<0.05),且TAP组术后自控PCA次数明显低于NTAP组(P<0.05),但在术后24h,患者VAS评分两组之间无统计学差异(P>0.05);两组患者术后镇痛并发症恶心呕吐的发生率TAP组明显低于NTAP组,具有明显统计学差异((P<0.05))。结论腹横筋膜阻滞在老年全身麻醉结肠癌根治手术中有良好的镇痛效果,能有效的减少术中阿片类药物的应用,减少老年患者术中的循环波动,在术后镇痛方面,能有效的减轻术后疼痛,减少术后镇痛并发症的发生。

Objective To investigate the application and postoperative analgesic effect of transverse abdominal fascia block in laparoscopic radical resection of colon cancer under general anesthesia in elderly patients.Methods Retrospective study elderly patients(60 or higher)in Beijing shi ji tan hospital affiliated to the capital university of medical sciences,from January 2017 to January 2019,who received laparoscopic colon cancer radical surgery under general anesthesia.A total of 68 cases were divided into two groups:abdominal transverse fascia block for the TAP group(31 cases),no abdominal transverse fascia block for NTAP group(37 cases).We compare the two groups of patients’mean arterial pressure after into the operation room(T0),5 minutes before the surgery(T1),operation began after 5 minutes(T2),out of the room 5 minutes before(T3),intraoperative fentanyl dosage,VAS scores at 1 h,12 hand 24 hpostoperatively,PCA frequency and postoperative nausea and vomiting incidence?rate.Results There was no significant difference in mean arterial pressure between the two groups(P>0.05)at T0 and T1,but there was significant difference in mean arterial pressure between the two groups(P<0.05)at T2 and T3,and there was significant difference in the NTAP group between T1 and T2(P<0.05),but there was on significant in the TAP group(P>0.05).The total amount of remifentanil in the TAP group was significantly lower than that in the NTAP group,with statistical difference(P<0.05).In terms of postoperative analgesia,the VAS score of the TAP group was significantly lower than that of the NTAP group at 1 hand 12 hpostoperatively(P<0.05),and the postoperative PCA frequency of the TAP group was significantly lower than that of the NTAP group(P<0.05).However,there was no statistical difference between the two groups at 24 hpostoperatively(P>0.05).The incidence of postoperative analgesic complications nausea and vomiting in the TAP group was significantly lower than that in the NTAP group,with significant statistical difference(P<0.05).Conclusion Transverse abdominal fascia block has a good analgesic effect in the radical operation of colon cancer under general anesthesia in the elderly.It can effectively reduce the application of opioids in the operation and reduce the circulation fluctuation in the operation of the elderly patients.In terms of postoperative analgesia,it can effectively reduce the postoperative pain and reduce the incidence of postoperative analgesia complications.